Wednesday, April 26, 2017

According to multiple sources, Representative Duncan Hunter
(R-CA) will introduce legislation tomorrow in the House of Representatives that
will create a new regulatory framework for electronic cigarettes and vaping
products. The bill is titled “The Cigarette Smoking Reduction and Electronic
Vapor Alternatives Act of 2017.”

Briefly, here is what the bill would do, in order of
importance:

1.The FDA would be precluded from regulating
electronic cigarettes under the same framework as tobacco cigarettes. Thus, the
bill would put an end to the requirement for e-cigarette companies to submit
pre-market tobacco applications and would not apply modified risk provisions to
vaping products.

2.The bill would set up a distinct regulatory
framework for electronic cigarettes, under the jurisdiction of the FDA’s Center
for Tobacco Products.

3.The bill would establish safety standards for
e-liquids and vaping devices that would go into effect one year after the
enactment of the legislation. These standards include:

a.Immediate adoption of the e-liquid standards
developed by the American E-Liquid Manufacturing Standards Association (AEMSA);

b.Subsequent adoption of the e-liquid standards
being developed by the American National Standards Institute (ANSI) once they
are established;

c.Immediate adoption of battery safety standards
set by the International Electrotechnical Commission;

d.Immediate requirement for short-circuit
protection for the heating element;

e.Battery overcharge protection;

f.Battery discharge protection; and

g.Tracking of all devices by serial and lot numbers.

4.The FDA would be required to review any
subsequent e-liquid standards established by AEMSA or ANSI and adopt such
standards if they are deemed to be appropriate for the protection of the public’s
health.

5.The FDA would be authorized to promulgate
regulations to prevent marketing of vaping products to minors.

6.The FDA would be required to conduct a health
safety assessment comparing the risks of different tobacco products as well as
vaping products and submit this report to Congress.

7.The FDA’s Center for Tobacco Products would be
renamed the “Center for Tobacco Products and Tobacco Harm Reduction.”

The Rest of the Story

This is critical and much-needed legislation that would put
an end to the lunacy going on with the current regulation by the FDA of cigarettes
and e-cigarettes. Right now, the FDA regulates e-cigarettes much more
stringently than real cigarettes, putting an almost insurmountable obstacle in
front of the development and marketing of electronic cigarettes – all to the
advantage of the real, maximum harm, tobacco cigarettes. The current
regulations will decimate the electronic cigarette industry, removing 99% of
vaping products from the market and eliminating much of the competition faced
by cigarettes for the nicotine market. This legislation would finally put an
end to such nonsense.

It makes perfect sense to carve out a separate regulatory
framework for electronic cigarettes that is separate from that for real
cigarettes. This is something I have been calling for repeatedly during the past
five years, and it is gratifying to see this potential approach finally seeing the
light of day.

The most interesting aspect of this story is what an
embarrassment it is for the FDA. While the FDA has had regulatory jurisdiction
over electronic cigarettes for the past seven years, it has not established a
single safety standard for these products. It has watched scores of people
being injured by exploding batteries and done nothing. Even worse, the agency
has actually prohibited companies from repairing this defective battery problem
because any such change would render the product a “new tobacco product,”
meaning that it could not be marketed without pre-approval – a process that
would take years and is prohibitively expensive for all but the largest of
companies.

Now, in one fell swoop, Representative Hunter and
co-sponsors are stepping in establishing almost immediate safety standards
(that go into effect in one year) that not only regulate battery safety, but
also regulate all aspects of e-liquid manufacturing. This is something that the
FDA could have and should have done years ago. But it has been too busy
developing its prohibitory approach to e-cigarettes rather than actually
working to protect the public’s health by assuring the maximum safety of
e-cigarettes being used by millions of Americans.

This bill is not perfect, but it is a superb start and with
a couple of amendments could be ideal. Here are the two major changes that I
believe are necessary:

1.The FDA should be given authority to set
additional safety standards, beyond the e-liquid standards established by AEMSA
and ANSI and the battery standards outlined in the bill. This is critical
because we don’t know what safety features will be uncovered as research into
e-cigarette safety continues and evolves. The FDA needs the flexibility to
establish additional safety standards as they are warranted.

2.The statute should explicitly address what
claims are allowed and disallowed in e-cigarette marketing; in particular, what
claims represent therapeutic claims and what claims are allowable without
making a product subject to regulation as a drug or device. Specifically, I
would like to see language that allows companies to truthfully inform their
consumers that vaping is much safer than smoking and that it can be effective in
helping many smokers to quit. Neither of these should be considered to be drug
claims and should be allowed as long as they are accurate.

Please note that this commentary pertains to the merits of the legislation. I am not commenting on the political strategy, the wisdom of introducing this bill at the same time as the Cole-Bishop rider is considered, or other political concerns. I defer to others who know more about the political climate than I do.

But from purely a public health policy perspective, this legislation makes sense. It needs to be strengthened by allowing the FDA to set additional safety standards and by explicitly allowing reduced risk and smoking cessation claims. However, it is a great start to correcting the lunacy of today's federal regulation of electronic cigarettes.

Tuesday, April 25, 2017

In 2011, the Food and Drug Administration (FDA) issued regulations that required graphic warning labels on cigarette packages. The FDA chose nine graphic images, such as a picture of a man with a chest scar from cardiac surgery, along with a telephone number for smokers to call for help with smoking cessation (1-800-QUIT-NOW). The tobacco companies subsequently challenged the rule, arguing that it violated their First Amendment rights by compelling them to commercial speech which is against their economic interests (i.e., speech which strongly encourages consumers to stop using the product). The D.C. district court overturned the regulations on this basis, a decision that was affirmed by the appellate court.

One of the issues in the case was whether the required warning labels represent merely factual and uncontroversial information or whether they are intended to elicit an emotional response that goes beyond merely the provision of factual information. In an apparent attempt to defend the regulations, new research published in the journal Tobacco Control reports the results of a study showing that graphic images can be informative and textual messages can evoke emotion, thus (supposedly) invalidating the court's reasoning in rejecting the rule.

The article concludes: "Our findings contradict courts’ conclusions that pictorial messages are
emotional and not factual. Pictorial labels are rated as informative and
factual, textual labels evoke emotion, and emotionality and
informativeness are strongly correlated. These findings serve as
evidence for the Food and Drug Administration (FDA) to counteract the
claim that pictorial warning labels, by definition, are not ‘purely
factual and uncontroversial’."

The Rest of the Story

There are a number of reasons why this analysis is wrong on the law, but the first is that it ignores the word "purely." What this paper shows is that graphic images can not only invoke emotion, but also provide information. If the criterion for applying a low level of scrutiny (i.e., using the Zauderer standard) was that a compelled statement must have factual content, then this research might be relevant. However, the issue at hand is whether the compelled statement is "purely" factual. With the FDA's proposed graphic warning labels, this was clearly not the case. The graphic images were specifically chosen to evoke high levels of emotion and therefore to accomplish the government's purpose of persuading smokers to quit. That this was the real purpose of the required labels is evidenced by the fact that the FDA included the 1-800-QUIT-NOW hotline number on the packages.

In order to apply the Zauderer standard, the intended purpose of the compelled speech must be to prevent the dissemination of misleading, deceptive, or false information. Compelling a manufacturer to include a warning message that persuades the consumer not to purchase the product has never been the type of commercial speech to which Zauderer has been applied, even if such a message conveys some factual information.

For example, the government can certainly require an alcohol manufacturer to include a warning on a bottle informing consumers that alcohol consumption is linked to adverse pregnancy outcomes, liver disease, or cancer. However, requiring the bottle to include the message "PLEASE DO NOT PURCHASE THIS PRODUCT. PLEASE STOP DRINKING IMMEDIATELY AND COMPLETELY" would obviously not fall under the Zauderer standard.

The bottom line is that the government cannot compel a company to provide warning labels that essentially hijack the packaging and use it as an anti-smoking billboard. The government is free to convey anti-smoking messages through its own advertisements. But it cannot hijack the companies' packaging and advertisements and compel speech that is specifically urging consumers not to purchase the product. Even if some factual information is conveyed, this does not fall under the Zauderer standard for a low level of scrutiny.

Monday, April 24, 2017

In a press release issued last Friday, the Campaign for Tobacco-Free Kids once again accused the tobacco companies of marketing cotton candy e-cigarettes to youth.

The press release states: "This bill would make it much harder for the FDA to limit the sale or
marketing of these products and, by making current products the industry
standard, much easier for tobacco companies to continue marketing
products in kid-friendly flavors like cotton candy and cherry crush."

The Rest of the Story

After an extensive internet search, I am unable to find a single tobacco company that markets cotton candy e-cigarettes.

It is now clear that the Campaign for Tobacco-Free Kids' repeated false statements are not merely a careless mistake. They are intentionally lying to the public in order to create a story that fits their pre-conceived model.

In my view, this behavior violates the public health code of ethics. Two key principles in this code are "truth telling" and "transparency" (i.e., not concealing information).

Not only is the Campaign failing to tell the truth regarding cotton candy e-cigarettes but it is also concealing information about the actual effect of the Cole-Bishop rider on the FDA's ability to restrict the marketing of e-cigarettes to youth. This amendment would not curtail the FDA's ability to regulate the marketing of e-cigarettes at all. The FDA remains free to promulgate any regulations it wants to restrict marketing of these products to youth. All the amendment does is to make it more difficult to market deadly tobacco cigarettes by ensuring that competition from much safer tobacco-free vapor products can continue. But the FDA is free to subject those products to any marketing restrictions that it deems advisable.

Honesty is critical in public health not only because it is essential to ethical conduct, but also because without it we risk losing the public's trust. The actions of the Campaign are therefore quite selfish: they are risking the credibility of the entire tobacco control movement just so that they can tell a more damning story about the tobacco industry to potential donors.

Monday, April 03, 2017

An expert at Penn Medicine - the University of Pennsylvania's health care system - is telling the public that smoking cigarettes, like Marlboros, Camels, and Newports, may be no more hazardous to your health than vaping a tobacco-free e-liquid.

According to the expert: "We know that cigarettes are unsafe after 40 years of
exposure. We don’t have 40 years of exposure to e-cigarettes
to know what the danger is. We don’t know the safety profile, so we
can’t say that e-cigarettes are safer than traditional cigarettes."

The Rest of the Story

Well, if we can't say that e-cigarettes are safer than traditional cigarettes, then what the expert is saying is that we can't say that smoking is any more hazardous than vaping.

This is an absurd statement, completely in conflict with scientific evidence, and not even the tobacco companies would make such a claim.

In fact, the tobacco companies could have a field day with this. If I were Altria, I would take out huge newspaper advertisements in all the leading papers stating: "Medical Expert Says that Smoking May Be No More Hazardous than Tobacco-Free Vaping."

In other words, the statement of this expert is essentially a huge advertisement for tobacco cigarettes, the most deadly consumer product on the market in terms of its toll on the lives and health of Americans.

The evidence that smoking is more hazardous than vaping is overwhelming. Asthmatic smokers who switch from smoking to vaping experience an immediate and dramatic improvement in their lung function, both measured subjectively in terms of respiratory symptoms and objectively in terms of spirometry testing. Hypertensive smokers who switch to vaping also experience a lowering of their blood pressure. A substantial decline in blood levels of many toxins and carcinogens has been documented in vapers compared to smokers.

In short, there just isn't any doubt that smoking is more hazardous than vaping. To suggest otherwise is not only incorrect, but it is damaging to the public's health.

Even the tobacco companies are not willing to lie to that extreme in order to promote cigarette smoking. While they easily could capitalize on statements like that of this Penn Medicine expert, they are refraining from doing so.

It's not clear to me why a medical professional would promote cigarette smoking in this way, but he has good company. A large number of medical and health organizations and agencies have made exactly the same claim.

The FDA and the CDC need to come out immediately with unequivocal statements that vaping is safer than smoking. Their failure to do so is a huge part of what is contributing to the deception of the public about the relative risks of vaping and smoking.

About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.